SPOTLIGHT: Dr. Sharon Sweeney Fee, Part Two     Editor’s Note: Publisher Laura Carabello met Dr. Sweeney Fee at the recent medical travel meeting in Korea. In our last issue, we featured Part I of a discussion between the two after that meeting. The conclusion of the conversation follows below. Medical Travel Today (MTT): What about post-operative care communications between the doctors in the home country and the destination country? Do you see any need for that? Sharon Sweeney Fee (SSF): I think there’s always a benefit when the physicians can clarify with each other any questions they may have, and make sure the patients are getting the appropriate follow up care. People think because they can send emails anywhere that doctors can do it as well.  Emails are not a protected form of communication and can easily be hacked. For HIPAA laws, a generic email shouldn’t be communicated.  If providers really want to talk to each other, they’re going to find a way to figure out a date and time that they can actually talk to each other on the phone. Of course, there might be a language concern. That’s the thing, language concerns. I know in my little rural hospital in Montana, we have a hard to time finding someone on our staff that can speak a particular foreign language to make a call — and hope that the destination location has somebody that can speak a little bit of English. We frequently do have someone who can speak a little bit of Italian, French or Russian; meaning we typically do have someone that can speak on a basic level and that is willing to be part of the call. For in-hospital patients, we offer interpretation services that are available via subscription and can provide assistance for the actual medical care. For conversations between providers, this is another step that we really need to consider. I know at the medical tourism conference, they talked a lot about partnerships with U.S. hospitals and where they can have a better exchange of information because they are using the same system. If multiple hospitals are using the same system, they can share information much more readily. MTT: What is your perspective on the globalization of healthcare and whether or not this is growing? Do you see any trends? SSF: I think globalization offers a lot more options for care. I know there are different needs among different patients. The reasons they travel can vary – whether they are seeking better care, or a certain type of care, or less costly care. What I do know is that even if global medical tourism is growing, the problem we are having — and have had for a long time – is ensuring the safe sharing of patient information regarding procedures for patients that travel. Whether patients travel from state-to-state, city-to-city or country-to-country, the problems with time-zone changes and language differences are just being exacerbated. I know the industry is looking at the health information exchanges as a panacea, but I think they’re really going to have to be more patient-directed, and not provider-managed. MTT: I am so surprised to hear you say that because I am familiar with so many of them that seem to be thriving.  SSF: Many of them do have some basic information, but when you’re really talking about someone who travels out of the country for a surgical procedure that can be as detailed as a joint replacement, there’s a lot of information that is not going to be expressed easily. Unfortunately, the physician doesn’t get the full story of what happened — and physicians really want the full story. I sure would want them to have the full story for my own surgery! MTT: What is the role of the nurse in this whole equation? SSF: In the nurse case management model, nurses can be the person that works with the patient to make sure they have the information needed before leaving and when they come back in order to receive the proper follow-up care upon their return. Nurses can help to navigate the system. Just as in medical tourism where there are people that help to navigate travel out of the country, the nurse case manager helps them navigate their care needs: accessing care, making sure they have their follow up appointments, ensuring that their antibiotics are working, dealing with a fever and arranging for current treatment. This is a very cost-effective model. Instead of patients waiting until something goes really wrong and then getting into an emergency room and trying to follow up with a doctor, the nurse case manager can arrange for care in an appropriate manner. MTT: Would it be your recommendation that all medical travel facilitators, travel agents and others involved in the process have some sort of nursing advisor or staffer that would ensure streamlined, quality care? SSF: I would hugely recommend that they work with a nurse — I really do. I think just as complex as arranging travel is ensuring that patient records are transferred.  Nurses can coordinate that. We do it on a daily basis in the hospital, and I think with many patients doing medical travel and the insurance companies paying everybody in travel to make arrangements, they’d welcome the input of a nurse to make sure the information is flowing back and forth. The troubles Dr. Hill talked about will not go away unless they start to look at some kind of case management. MTT: Your advice is very well taken. Do you think that the nursing community or the American Nurses Association would be interested in focusing on something of this nature? SSF: That is something that I haven’t really thought of in much detail, but I really do think there’s a lot of arenas where nursing is kind of that bridge — just as I am the bridge between the clinicians and the computer department in my professional role and in what I do. I think we can really see a role for nurses to provide this bridge. It’s going to take the insurance companies and medical tourism industry to decide if they want to hire nurse case managers. Then it’s going to take some attention to licensing requirements. What we’re really dealing with here is the issue of an individual’s nursing license to work in other states. I think if it’s within the case management realm and within the insurer’s business model, then there’s some protection for the nurse working within the confines of the state license in place. MTT: That would be an important factor.  SSF: Yes.  There are a lot of issues here. I think it’s something the nursing community deals with on a daily basis, but our decisions with regard to policy and health tourism have not been there. I think it’s something we’re kind of watching and dealing with on many different levels, but so much of this has been really insurance-driven and separate from the healthcare industry that is driving it. MTT: Exactly. SSF: There are a lot of gaps that Dr. Hill identified that we’re starting to recognize and address in this country because we realize that it is happening. Data reveals hundreds of thousands of people traveling for care. We’re all thinking about how to make sure that this is going to work best for the patients — before they go and when they come back. The medical travel industry doesn’t realize there is a role for nursing in this continuum. Some of the issues that the industry keeps trying to deal with can be solved with a nurse case manager model. I do think this is something that I will definitely pass on to my colleagues. I know it is something we really need to be looking at  — as nurses and in helping to manage the care of these patients. After reading the interview with Dr. Hill, it really sunk in that we can do things better and how we, as nurses and the American Nursing Association, can approach these issues and maybe have some discussions with each other as to what would be the best way to address this. MTT: So, it might be a new topic for a meeting or something that the nurses are focusing on.  SSF: Yes. It would definitely be something we could look at. A lot of this is focused on the regulations and standards of practice, and the issues with regard to nurse case management and working across state lines and countries. We would need to have conversations about this because nurses won’t leap into the entrepreneurship role if they’re not sure their license is going to be protected. They’re not going to be working outside the scope of that license that they hold, so there are still those issues we deal with on a regular basis whenever there is a new healthcare delivery model. About Dr. Sweeney Fee Dr. Sweeney Fee is a nurse informatics specialist, helping to implement an electronic health record at a rural healthcare system in Livingston, Mont. In 2009, Sharon worked as a Research Scientist on the Knowledge-Based Nursing Initiative (KBNI), with Aurora HealthCare in Milwaukee, Wisc. The KBNI is a project that evaluated nurses’ workflow, embedded best evidence into nurses’ workflow, and evaluated nursing process and patient outcomes in an electronic environment. Sharon has a Ph.D in Nursing from the University of Arizona with a focus on health systems and vulnerable populations. Sharon is currently serving as chair of the Advisory Board for the ANA Committee on Ethics and Human Protections; and is active in her community, serving on both the Sixth Judicial CASA/GAL and Joe Brooks Trout Unlimited Boards of Directors. About the American Nurses Association and the Committee on Ethics The American Nurses Association (ANA) is the only full-service professional organization representing the interests of the nation’s 3.1 million registered nurses through its constituent member nurses associations and its organizational affiliates. The ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on healthcare issues affecting nurses and the public. In September 1990, the Center for Ethics and Human Rights was established with the following guiding objectives: *Promulgate in collaboration with ANA constituents, a body of knowledge, both theoretical and practical, designed to address issues in ethics and human rights at the state, national and international level; *Develop and disseminate information about and advocate for public policy to assure that ethics and human rights are addressed in health care; and *Assure that short and long-range objectives regarding ethics and human rights will be addressed within the Association, and expressed to appropriate bodies external to the Association.